,i  #aag? ,,congress  #a/ ,session  ,h4 
,r4 #efef  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,octob] #ba1 #bjba,mr4
 ,la,turner 7= himself1 ,mr4 ,smi? (    
,new ,j]sey1 ,mr4 ,banks1 ,mrs4         
,mill]-,meeks1 ,mrs4 ,h9son1 ,mr4 ,mann1
 ,mr4 ,e/es1 ,ms4 ,salaz>1 ,mr4 ,moore (
 ,utah1 ,mrs4 ,bice ( ,oklahoma1 ,mr4   
,b>r1 ,mr4 ,bab91 ,mr4 ,caw?orn1 ,mrs4  
,lesko1 ,mr4 ,lamborn1 ,mr4 ,latta1 ,ms4
 ,van ,duyne1 ,mr4 ,good ( ,virg9ia1    
,ms4 ,letl[1 ,mr4 ,mull91 ,mr4 ,h>ris1  
,mr4 ,duncan1 ,mr4 ,ros5dale1 ,mr4      
,jackson1 ,mr4 ,c4 ,scott ,frankl9 (    
,florida1 ,mr4 ,williams ( ,texas1 ,mr4 
,ku/(f1 & ,mrs4 ,mill] ( ,ill9ois7      
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce1 & 9 
addition to ! ,committee on ,ways &     
,means1 = a p]iod to be subsequ5tly     
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d titles ,,xviii & ,,xix
 ( ! ,social ,security ,act to require  

provid]s ( s]vices & heal? ma9t5ance    
organizations "u ! ,m$ic>e & ,m$icaid   
programs to provide = c]ta9 policies to 
be 9 place relat+ to d-n-resuscitate    
ord]s or simil> physician's ord]s =     
unemancipat$ m9ors receiv+ s]vices4  #a4
 ,%ort title ,?is ,act may be cit$ z !  
,simon ,crosi] ,act4  #b4 ,m$ic>e &     
,m$icaid requirem5ts = c]ta9 policies   
relat+ to d-n-resuscitate ord]s or      
simil> physician's ord]s  7a7 ,m$ic>e   
provid] agreem5t requirem5t  7#a7 ,9    
g5]al ,section #ahff7;f7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acie;cc7f77 is am5d$ by add+ at ! end !
 foll[+ new p>agraphs3  7#e7 ,= purposes
 ( subsection 7a77#a77,q7 & sections    
#ahai7;c77#a77;,e71 #ahcc7s71 #aheb7;i71
 #ahgf7;c77#h71 & #ahia7;a77#f71 !      
requirem5t ( ?is subsection1 9 addition 
to p>agraph 7#a71 is t a provid] (      
s]vices1 ,,ma organization1 or prepaid  
or eligible organization 7z ! case may  
be7 ma9ta9 ! foll[+ writt5 policies &   
proc$ures ) respect to all unemancipat$ 

m9ors receiv+ m$ical c>e by or ?r\gh !  
provid] or organization 7or prospective 
pati5t or resid5t1 ) respect to !       
provid] or organization1 :o is an       
unemancipat$ m9or73 7,a7 ,a             
d-n-resuscitate ord] or simil>          
physician's ord] %all n be in/itut$1    
ei!r orally or 9 writ+1 unless at lea/  
"o p>5t or legal gu>dian ( su*          
unemancipat$ m9or has fir/ be5 in=m$ ( !
 physician's int5t to in/itute su* an   
ord] & a reasonable attempt has be5 made
 to in=m ! o!r p>5t if ! o!r p>5t is    
reasonably available & has cu/odial or  
visitation rights4 ,su* in=mation mu/ be
 provid$ bo? orally & 9 writ+ unless1 9 
reasonable m$ical judgm5t1 ! urg5cy ( ! 
decision requires reliance on only      
provid+ ! in=mation orally4 ,oral       
provision ( su* in=mation %all include  
speak+ to at lea/ "o p>5t or legal      
gu>dian 9 p]son or on ! telephone1 &    
%all n be limit$ to record$ voice       
messages4 ,provision ( su* in=mation    
%all include at lea/ #gb h\rs ( dilig5t 

ef=ts made by ! physician or provid] to 
contact & notify at lea/ "o p>5t or     
legal gu>dian4 ,! provision ( su*       
in=mation %all be contemporane\sly      
record$ 9 ! m$ical record ( !           
unemancipat$ m9or1 specify+ by :om & to 
:om ! in=mation 0 giv51 ! date & "t (   
its provision1 & :e!r x 0 provid$ 9     
writ+4 ,9 ! case t only "o p>5t has be5 
in=m$1 ! nature ( reasonable attempts to
 in=m ! o!r p>5t or ! reason :y su*     
attempts 7 n made %all be               
contemporane\sly record$ 9 ! m$ical     
record ( ! unemancipat$ m9or4  7,b7     
,ei!r p>5t ( ! unemancipat$ m9or or !   
unemancipat$ m9or's gu>dian may refuse  
cons5t = a d-n-resuscitate ord] or      
simil> physician's ord] = !             
unemancipated m9or1 ei!r 9 writ+ or     
orally4 ,any su* refusal ( cons5t mu/ be
 contemporane\sly record$ 9 ! m$ical    
record ( ! unemancipat$ m9or4 ,no       
d-n-resuscitate ord] or simil>          
physician's ord] %all be in/itut$ ei!r  
orally or 9 writ+ if !re has be5 su* a  

refusal ( cons5t4  7,c7 ,! provid] %all 
n h ! au?ority to require ! )hold+ or   
)drawal ( life-su/a9+ proc$ures f an    
unemancipated m9or ov] ! objection ( !  
p>5t or legal gu>dian1 unless electronic
 bra91 he>t1 & respiratory monitor+     
activity conclusively e/abli%es t ! m9or
 has di$4 ,!re %all be a presumption t !
 cont9uation ( life is 9 ! m9or's be/   
int]e/4  7,d7 ,)9 #dh h\rs ( be+ notifi$
 ( ! int5t to in/itute a d-n-resuscitate
 ord] or a simil> physician's ord]      
accord+ to subp>agraph 7,a71 a p>5t or  
legal gu>dian may reque/ a transf] ( !  
unemancipat$ m9or pati5t or resid5t to  
ano!r facility or dis*>ge4 ,if a transf]
 is reque/$ by a p>5t or legal gu>dian1 
! hospital or heal? c>e facility "u ^:  
c>e ! unemancipat$ m9or is admitt$ mu/  
cont9ue provision ( artificial          
life-su/a9+ proc$ures & life-su/a9+     
artificial nutrition & hydration = a    
m9imum ( #ae days aft] ! transf] reque/ 
has be5 made kn[n & make e reasonable   
ef=t to assi/ ! reque/+ p>5t or legal   

gu>dian 9 ! transf] process4 ,! hospital
 or heal? c>e facility's duties &       
f9ancial obligations reg>d+ transf] %all
 be gov]n$ by exi/+ ,/ate law1          
applicable rules or regulations1        
hospital policy1 & relevant ?ird-p>ty   
paym5t contracts4  7,e7 ,^u ! reque/ ( a
 pati5t or resid5t or a prospective     
pati5t or resid5t1 ! provid] ( s]vices  
or organization %all disclose 9 writ+   
any policies relat+ to ! pati5t or      
resid5t or ! s]vices ! pati5t or resid5t
 may receive involv+ resuscitation or   
life-su/a9+ measures1 includ+ any       
policies relat$ to treatm5ts deem$      
non-b5eficial1 ineffective1 futile or   
inappropriate1 )9 ! provid] ( s]vices or
 organization4 ,no?+ 9 ?is subp>agraph  
%all require a provid] ( s]vices or     
organization to h a writt5 policy relat+
 to or involv+ resuscitation1           
life-su/a9+ or non-b5eficial treatm5t = 
unemancipated m9or pati5ts or adult     
pati5ts1 resid5ts or w>ds4  7#f7 ,9     
apply+ p>agraph 7#e77;,a71 a det]m9ation

 bas$ on 8reasonable m$ical judgem5t0   
%all n be solely bas$ on disability     
alone or ! view t ! life ( a p]son ) a  
disability is ( l[] value or ( l[]      
quality ?an t ( a p]son )\t a disability
 reg>dless ( :e!r ! p]son's disability  
is pre-exi/+ or newly acquir$ & !re=e   
mu/ n s]ve z ! sole basis = !           
d-n-resuscitate ord] or simil>          
physician's ord] unless treatm5t is     
det]m9$ to be physiologically futile &  
support$ ) objective evid5ce t is       
docum5t$ 9 ! pati5t's records 9 writ+4  
4  7#b7 ,con=m+ am5dm5ts  7,a7 ,section 
#ahff7;a77#a77,q7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acie;cc7a77#a77,q77
 is am5d$-- 7i7 by /rik+ requirem5t &   
ins]t+ requirem5ts2 &  7ii7 by ins]t+ & 
c]ta9 d-n-resuscitate ord]s or simil>   
physician's ord]s aft] advance          
directives4  7,b7 ,section              
#ahai7;c77#a77;,e7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acie;i-#c7;c77#a77;,e77 is am5d$-- 7i7 
by /rik+ requirem5t & ins]t+            

requirem5ts2 &  7ii7 by ins]t+ & c]ta9  
d-n-resuscitate ord]s or simil>         
physician's ord]s aft] advance          
directives4  7,c7 ,section #ahcc7s7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciel7s77 is am5d$-- 7i7 by /rik+      
requirem5t & ins]t+ requirem5ts2 &  7ii7
 by ins]t+ & c]ta9 d-n-resuscitate ord]s
 or simil> physician's ord]s aft]       
advance directives4  7,d7 ,section      
#aheb7;i7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #aciew-#bb7;i77 is       
am5d$-- 7i7 by /rik+ requirem5t & ins]t+
 requirem5ts2 &  7ii7 by ins]t+ & c]ta9 
d-n-resuscitate ord]s or simil>         
physician's ord]s aft] advance          
directives4  7,e7 ,section #ahgf7;c77#h7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #aciemm7c77#h77 is am5d$-- 7i7
 by /rik+ requirem5t & ins]t+           
requirem5ts2 &  7ii7 by ins]t+ & c]ta9  
d-n-resuscitate ord]s or simil>         
physician's ord]s aft] advance          
directives4  7,f7 ,section #ahia7;a77#f7
 ( ! ,social ,security ,act 7#db        

,u4,s4,c4 #acie;bbb7a77#f77 is am5d$--  
7i7 by /rik+ requirem5t & ins]t+        
requirem5ts2 &  7ii7 by ins]t+ & c]ta9  
d-n-resuscitate ord]s or simil>         
physician's ord]s aft] advance          
directives4  7#c7 ,effective date ,!    
am5dm5ts made by ?is subsection %all    
apply ) respect to items & s]vices      
furni%$ on or aft] ! date t is #ij days 
aft] ! date ( ! enactm5t ( ?is ,act4    
7b7 ,m$icaid ,/ate plan requirem5t  7#a7
 ,9 g5]al ,section #aijb7w7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acif;a7w77 is am5d$ by add+ at ! end ! 
foll[+ new p>agraphs3  7#f7 ,= purposes 
( subsection 7a77#eg7 & sections        
#aijc7m77#a77;,a7 & #aiai7;c77#b77;,e71 
! requirem5t ( ?is subsection1 9        
addition to p>agraph 7#a71 is t a       
provid] or organization 7z ! case may   
be7 ma9ta9 ! foll[+ writt5 policies &   
proc$ures ) respect to all unemancipat$ 
m9ors receiv+ m$ical c>e by or ?r\gh !  
provid] or organization 7or prospective 
pati5t or resid5t1 ) respect to !       

provid] or organization1 :o is an       
unemancipat$ m9or73 7,a7 ,a             
d-n-resuscitate ord] or simil>          
physician's ord] %all n be in/itut$1    
ei!r orally or 9 writ+1 unless at lea/  
"o p>5t or legal gu>dian ( su*          
unemancipat$ m9or has fir/ be5 in=m$ ( !
 physician's int5t to in/itute su* an   
ord] & a reasonable attempt has be5 made
 to in=m ! o!r p>5t if ! o!r p>5t is    
reasonably available & has cu/odial or  
visitation rights4 ,su* in=mation mu/ be
 provid$ bo? orally & 9 writ+ unless1 9 
reasonable m$ical judgm5t1 ! urg5cy ( ! 
decision requires reliance on only      
provid+ ! in=mation orally4 ,oral       
provision ( su* in=mation %all include  
speak+ to at lea/ "o p>5t or legal      
gu>dian 9 p]son or on ! telephone1 &    
%all n be limit$ to record$ voice       
messages4 ,provision ( su* in=mation    
%all include at lea/ #gb h\rs ( dilig5t 
ef=ts made by ! physician or provid] to 
contact & notify at lea/ "o p>5t or     
legal gu>dian4 ,! provision ( su*       

in=mation %all be contemporane\sly      
record$ 9 ! m$ical record ( !           
unemancipat$ m9or1 specify+ by :om & to 
:om ! in=mation 0 giv51 ! date & "t (   
its provision1 & :e!r x 0 provid$ 9     
writ+4 ,9 ! case t only "o p>5t has be5 
in=m$1 ! nature ( reasonable attempts to
 in=m ! o!r p>5t or ! reason :y su*     
attempts 7 n made %all be               
contemporane\sly record$ 9 ! m$ical     
record ( ! unemancipat$ m9or4  7,b7     
,ei!r p>5t ( ! unemancipat$ m9or or !   
unemancipat$ m9or's gu>dian may refuse  
cons5t = a d-n-resuscitate ord] or      
simil> physician's ord] = !             
unemancipated m9or1 ei!r 9 writ+ or     
orally4 ,any su* refusal ( cons5t mu/ be
 contemporane\sly record$ 9 ! m$ical    
record ( ! unemancipat$ m9or4 ,no       
d-n-resuscitate ord] or simil>          
physician's ord] %all be in/itut$ ei!r  
orally or 9 writ+ if !re has be5 su* a  
refusal ( cons5t4  7,c7 ,! provid] %all 
n h ! au?ority to require ! )hold+ or   
)drawal ( life-su/a9+ proc$ures f an    

unemancipated m9or ov] ! objection ( !  
p>5t or legal gu>dian1 unless electronic
 bra91 he>t1 & respiratory monitor+     
activity conclusively e/abli%es t ! m9or
 has di$4 ,!re %all be a presumption t !
 cont9uation ( life is 9 ! m9or's be/   
int]e/4  7,d7 ,)9 #dh h\rs ( be+ notifi$
 ( ! int5t to in/itute a d-n-resuscitate
 ord] or a simil> physician's ord]      
accord+ to subp>agraph 7,a71 a p>5t or  
legal gu>dian may reque/ a transf] ( !  
unemancipat$ m9or pati5t or resid5t to  
ano!r facility or dis*>ge4 ,if a transf]
 is reque/$ by a p>5t or legal gu>dian1 
! hospital or heal? c>e facility "u ^:  
c>e ! unemancipat$ m9or is admitt$ mu/  
cont9ue provision ( artificial          
life-su/a9+ proc$ures & life-su/a9+     
artificial nutrition & hydration = a    
m9imum ( #ae days aft] ! transf] reque/ 
has be5 made kn[n & make e reasonable   
ef=t to assi/ ! reque/+ p>5t or legal   
gu>dian 9 ! transf] process4 ,! hospital
 or heal? c>e facility's duties &       
f9ancial obligations reg>d+ transf] %all

 be gov]n$ by exi/+ ,/ate law1          
applicable rules or regulations1        
hospital policy1 & relevant ?ird-p>ty   
paym5t contracts4  7,e7 ,^u ! reque/ ( a
 pati5t or resid5t or a prospective     
pati5t or resid5t1 ! provid] ( s]vices  
or organization %all disclose 9 writ+   
any policies relat+ to ! pati5t or      
resid5t or ! s]vices ! pati5t or resid5t
 may receive involv+ resuscitation or   
life-su/a9+ measures1 includ+ any       
policies relat$ to treatm5ts deem$      
non-b5eficial1 ineffective1 futile or   
inappropriate1 )9 ! provid] ( s]vices or
 organization4 ,no?+ 9 ?is subp>agraph  
%all require a provid] ( s]vices or     
organization to h a writt5 policy relat+
 to or involv+ resuscitation1           
life-su/a9+ or non-b5eficial treatm5t = 
unemancipated m9or pati5ts or adult     
pati5ts1 resid5ts or w>ds4  7#g7 ,9     
apply+ p>agraph 7#f77;,a71 a det]m9ation
 bas$ on 8reasonable m$ical judgem5t0   
%all n be solely bas$ on disability     
alone or ! view t ! life ( a p]son ) a  

disability is ( l[] value or ( l[]      
quality ?an t ( a p]son )\t a disability
 reg>dless ( :e!r ! p]son's disability  
is pre-exi/+ or newly acquir$ & !re=e   
mu/ n s]ve z ! sole basis = !           
d-n-resuscitate ord] or simil>          
physician's ord] unless treatm5t is     
det]m9$ to be physiologically futile &  
support$ ) objective evid5ce t is       
docum5t$ 9 ! pati5t's records 9 writ+4  
4  7#b7 ,con=m+ am5dm5ts  7,a7 ,section 
#aijc7m77#a77;,a7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acif;b7m77#a77;,a77
 is am5d$ 9 ! matt] prec$+ clause 7i71  
by /rik+ requirem5t & ins]t+            
requirem5ts4  7,b7 ,section             
#aiai7;c77#b77;,e7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acifr7c77#b77;,e77
 is am5d$-- 7i7 by /rik+ requirem5t &   
ins]t+ requirem5ts2 &  7ii7 by ins]t+ & 
c]ta9 d-n-resuscitate ord]s or simil>   
physician's ord]s aft] advance          
directives4  7#c7 ,effective date  7,a7 
,9 g5]al ,except z provid$ 9 p>agraph   
7#b71 ! am5dm5ts made by ?is subsection 

%all take effect on ! date ( ! enactm5t 
( ?is ,act & %all apply to s]vices      
furni%$ on or aft] ! date t is #ij days 
aft] ! date ( ! enactm5t ( ?is ,act4    
7,b7 ,exception if ,/ate legislation    
requir$ ,9 ! case ( a ,/ate plan =      
m$ical assi/ance "u title ,,xix ( !     
,social ,security ,act :i* ! ,secret>y (
 ,heal? & ,human ,s]vices det]m9es      
requires ,/ate legislation 7o!r ?an     
legislation appropriat+ funds7 9 ord] = 
! plan to meet ! additional requirem5t  
impos$ by ! am5dm5ts made by ?is        
subsection1 ! ,/ate plan %all n be      
reg>d$ z fail+ to comply ) ! requirem5ts
 ( su* title solely on ! basis ( its    
failure to meet ?is additional          
requirem5t be=e ! fir/ day ( ! fir/     
cal5d> qu>t] beg9n+ aft] ! close ( !    
fir/ regul> session ( ! ,/ate           
legislature t beg9s aft] ! date ( !     
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 su* session %all be deem$ to be a      

sep>ate regul> session ( ! ,/ate        
legislature4